UNC School of Medicine researchers Katrina Donahue, MD, MPH, and Laura Young, MD, PhD, have been awarded $1.3 million for the PCORI Dissemination and Implementation project titled “Rethink the Strip: De-adoption of Glucose Monitoring for Non-Insulin Treated Type 2 Diabetes in Primary Care.” The Patient-Centered Outcomes Research Institute (PCORI) funds studies that help patients and those who care for them make better-informed healthcare decisions.
“Rethink the Strip” is a continuation of a landmark study led by Young and Donahue. Their 2017 MONITOR Trial showed blood glucose testing does not offer a significant advantage in blood sugar control, or quality of life, for type 2 diabetes patients who are not treated with insulin. The study was the first large pragmatic study examining glucose monitoring in the United States. The results were published in JAMA Internal Medicine last summer.
Today in the United States, most of the 25 million people with type 2 diabetes do not take insulin. They control their blood sugar with exercise, diet, and sometimes medications such as metformin. Currently, 75 percent of non-insulin treated type 2 diabetes patients perform regular blood glucose testing at home, generally at the recommendation of a provider.
“This project fits well into national efforts to curb overtreatment and the use of low value tests by addressing questions related to the delivery of primary care health services,” said Donahue, professor and vice-chair of research in the department of family medicine, who also co-directs the North Carolina Network Consortium. “De-adoption strategies may also provide more time and resources for clinicians and patients to focus on behavioral strategies and other treatments with proven effectiveness for patients with type 2 diabetes who are not on insulin.”
De-adoption is the discontinuation of an established medical practice. Over the next three years, co-PI’s Young and Donahue will create a comprehensive strategy to disseminate their findings on glucose monitoring to primary care practices, healthcare providers, patients, and insurance providers. The aim is to encourage de-adoption of glucose monitoring among patients with type 2 diabetes who are not treated with insulin.
“There are many care recommendations in the field of diabetes that we know work well for patients,” said Young, associate professor of medicine in endocrinology. “Unfortunately, many of these treatments and interventions never leave the confines of academia. This project is important because it will enable us to communicate an important message to patients and health care providers, that glucose monitoring for patients who do not require insulin is unnecessary in most cases.”
The researchers will evaluate the effectiveness of these dissemination strategies, with the end goal being to employ them on a national level.
“Freeing patients from this unnecessary burden will allow them to focus on other more fruitful areas of lifestyle modification,” Young said.
PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI’s funding, visit www.pcori.org.
Young and Donahue’s award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.